Don’t take Kardashian GYNO advice and put Vitamin E in your vagina

The latest celebrity to use the Internet like a a public speculum is Khloe Kardashian. I know this because my phone blew up yesterday with reporters texting, e-mailing and sending direct messages on Twitter asking about vaginal vitamin E. So I gave some quotes and thought it would all die down because, hey, the President spoke last night and a woman accepted the nomination to run for President!

But no. Kardashian vagina ranks up there in national significance with the first woman running for the highest office and threats of Russian espionage, so here we are.

“Strengthening tissue,” what Khloe claims vitamin E will do, is one of those quasi medical terms often favored by those selling quack cures and supplements. I’m going to guess she means less likely to tear with penetration. Here’s some advice, if your vagina is tearing during sex you have a medical problem and should go to a board certified gynecologist. If your vagina is fine and sex feels good, then leave it alone.

Healthy vaginal tissue will not tear unless is is treated inappropriately, for example sex with no foreplay or lube (i.e. twist a nipple then stick it in). This is because it has evolved to stretch. It’s also designed to withstand friction, because procreation involves friction.

The vaginal mucosa (lining) has a protective layer of mucous and lactobacilli (good bacteria). The lactobacilli lower the pH and produce hydrogen peroxide, which actually kills harmful bacteria. The effect of vitamin E on this bacteria or the mucus is unknown.

See all those purple rectangles and squares? Those are the cells of the vagina mucosa (see the picture below for what they really look like under a microscope), layers of specialized skin cells that line the vagina and the layer directly underneath the mucus. I had a histology professor who used to say “It looks so rough but it feels so smooth.” Hey, mucus is our friend!

Anyway, there are lots of layers because during sex the friction can rub off several of the top rows. If that were your knee you’d have an abrasion, but because this is the vagina there are redundant layers for protection and as soon as the top layers are rubbed off more are produced (it’s a bit like shark’s teeth being constantly replaced, no dentate vagina jokes intended). The effect of vitamin E of cell turn over in this layer is unknown.

The skin cells are also filled with glycogen which makes them plump, providing more cushion. The glycogen breaks down when the cells are shed and feeds the lactobacilli. We don’t know how vitamin E can affect that either.

Basically, it’s a well functioning ecosystem.

Estrogen is the fuel that drives the vaginal epithelium-glycogen-lactobacilli complex and without it the layers of epithelium thin out, new cells are produced at a slower rate, and they have less glycogen (the prepubertal and post menopausal images above). The vaginal mucosa becomes more fragile and can tear with minor contact. Other things that can lead to vaginal tearing are chronic yeast infections, skin conditions, and spasm of the levator ani muscles that surround the vagina (this causes a smaller vaginal opening so more trauma on contact with penetration).

There is one small study looking at a compound with vitamin E mixed with hyaluronic acid and vitamin A in menopausal women, but it’s a low quality study. Some studies support vitamin E to protect the vulva against radiation injury during cancer treatment, but that cannot be extrapolated to health maintenance for women of reproductive age. It would be like saying you are going to apply sunscreen to prevent a sunburn so you will also put it on your hands so you don’t get burned taking a pan out of a hot oven.

Okay you say, there is no evidence that vitamin E will make vaginal tissue healthier, but I’m willing to assume unknown effects on my good bacteria because I like how it feels. It is an oil so if that’s what you like to use as an external moisturizer or as a lube for sex, stick with coconut oil or olive oil. This is because studies suggest that vitamin E supplementation increases all cause mortality. The skin a and vagina are both very efficient ways to absorb a variety compounds, so how much be absorbed if you are “slathering” it everywhere as recommended by Ms. Kardashian recommends? Right.

It is important to remember that anti oxidants could easily have negative effects, such as promoting the growth of cancer cells. Vitamin E doesn’t know which cell is healthy and which is cancer. What could this do to a cell infected with the human papilloma virus? What if removing free radicals is preferentially better for a cell infected with high risk HPV?

Mega doses of vitamins are gradually proving to be a big bust. Just because something is found in nature doesn’t make it safe, for example we need oxygen to live but pure.oxygen can be highly damaging to the lungs. Slathering something associated with an increase in all cause mortality all over your body isn’t advisable.

It’s best to eat your vitamins in food.

If you don’t have any vagina issues don’t create them by taking advice from a Kardashian.

If you vagina hurts or you have pain with sex, see a gynecologist.

Khloe Kardashian may not give good GYNO advice, but she is without a doubt a PR genius.

While I agree that one shouldn’t listen to any of the Kardashians you’re missing the all too common case of women who have pain with sex and the GYNO can’t find anything wrong. Your if-it-hurts-go-to-the-gyno all too often doesn’t solve the problem.

Then you are going to the wrong gynecologist. There are many, like me, who specialize in pain with sex. If your GYNO has no cause ask for a 2nd opinion and a referral to a pelvic floor physical therapist

I don’t watch Kardashians so I had no idea one of them suggested this vitamin E thing, but I’ve actually done this for a long time. I’m a trans guy (female to male), on hormone therapy for about 5 years now. Obviously this mucks up the lower bits a little (elasticity and dryness wise). I was moisturizing daily with coconut oil for a year or so, but that wasn’t cutting it. I asked a couple FtM friends of mine what they did – vitamin E up the front was the suggestion, or else the gyn was going to try to smear you with estrogen cream they said (in a panic in some cases).
That being said – I’ve done 1 capsule up there ever other day, plus moisturizing with coconut oil for a few years now. But – I don’t want to screw things up down there if the vitamin E is bad for me. Any suggestions on what I could use that isn’t estrogen?
PS – I know I should probably see a gyn and ask this, but that won’t actually happen – I’d rather put an ice pick in my eye than go to an obgyn’s office.